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Introduction Anaesthesiologist  Resuscitation + management of trauma victims High index of suspicion Evaluation of C-spine Understanding the pathophysiology of SCI Evaluating the risks and benefts of various airway appliances

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Epidemiology Age years and >65 years (peak incidence) C.spine injuries- 1.8% of all trauma cases 20% more than one cervical spine fracture 20-70% unstable 30-70% associated neurological injury 3-25% of SCI are iatrogenic i.e. during field stabilization, transit or early management

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Patient coming in chronic phase After recovery from spinal shock Concerns –Autonomic hyperreflexia –Supersensitivity of cholinergic receptors Autonomic hyper-reflexia –Chronic spinal cord lesion above T6 –85% of patients have this at some time during the course of living –Uncontrolled reflex arc below the level of lesion

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Supersensitivity Denervation Cholinergic receptor proliferation beyond the motor end plate Muscle contracts for a minimal Ach (10 -4 to ) K+ released suddenly along entire length of muscle fibre Sch –4 to 10 meq/L increase in K+ –Duration of supersensitivity: From 1 week upto 6 months to 2 years So Sch is safe in the first days of paraplegia, avoid it after 3 rd or 4 th day